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CdK ‘02
ICIN
Intravascular Elastography:
palpating plaques with the finger of IVUS
C.L. de Korte1
, F. Mastik1
, J.A. Schaar1
,
M. Sierevogel1,3
,G. Pasterkamp3
,
P.W. Serruys1
and A.F.W van der Steen1,2
1
Erasmus University, Thoraxcentre, Rotterdam, The Netherlands
2
Interuniversity Cardiology Institute of the Netherlands
3
Experimental Cardiology Laboratory, University Medical Center, Utrecht, The Netherlands
Supported by Netherlands Organization for Scientific Research (NWO)
and the Dutch Technology Foundation (STW)
CdK ‘02
ICIN
Background : Vulnerable plaque
que vulnerability :
que composition
• Large lipid pool
Mechanical
properties
• High strain region
• Thin fibrous cap
• presence of Macrophages
CdK ‘02
ICIN
Background : Principle of elastography
Soft Harduncompressed
compressed
• The response of tissue to mechanical excitation (e.g.
compression) is a function of its mechanical
properties.
Force Soft Hard
CdK ‘02
ICIN
IVUS elastography
(t1, P1)
(t2,P2)
Processing
IVUS at 100mmHg
IVUS at 80mmHg
IVUS elastogram
strain
1%
0%
CdK ‘02
ICIN
strain
1%
0%
Picrosirius-red Anti-CD68 antibodyAlpha-actin
Circulation 102(6) 617-623 (2000)
IVUS elastography plaque characterization
CdK ‘02
ICIN
strain
1%
0%
Picrosirius-red Anti-CD68 antibodyAlpha-actin
IVUS elastography vulnerable plaque detection
ACC 2002, presentation 1054-20
CdK ‘02
ICIN
Predictive power of elastography
to identify the vulnerable plaque
1 - Specificity
1.00.75.50.25
Sensitivity
1.00
.75
.50
.25
0
Strain 1.26 %:
Sensitivity 88%
Specificity 89%
ACC 2002, presentation 1054-20
CdK ‘02
ICIN
0 20 40 60 80 100 120
40
60
80
100
120
140
Frame no.
Intra-coronary
pressure[mmHg]
In vivo elastography
Strain [%]
1.0
0.0
Eur Heart J 23(5): 405-413 (2002)
CdK ‘02
ICIN
Cross-section LAD of patient with U.A.P
Strain [%]
2.0
0.0
CdK ‘02
ICIN
IVUS elastography before atherectomy
Strain [%]
1.0
0.0
CdK ‘02
ICIN
Fibrous cap tissue
Fibro-fatty core tissue
Histology atherectomy specimen
CdK ‘02
ICIN
Echogram and elastogram obtained in vivo in Yucatan
strain
1%
0%
Elastic-von Giesson Picro-Sirius red Acid Phosphatase
Polarized light
Circulation (2002) in press
CdK ‘02
ICIN
Tissue mean std
Normal segments (n=6) 0.21 0.09
Early fatty lesion (n=9) 0.46 0.17
Early fibrous lesion (n=3) 0.24 0.03
Advanced fibrous lesion (n=6) 0.22 0.04
Strain [%]
*
Strain and plaque composition in Yucatan
Univariate ANOVA on strain
Fat p=0.007
MΦ p=0.966
1 - Specificity
1.00.75.50.250.00
Sensitivity
1.00
.75
.50
.25
0.00
Area=0.952
Circulation (2002) in press
CdK ‘02
ICIN
3 Dimensional Elastography
CdK ‘02
ICIN
Conclusion
Intravascular Ultrasound Elastography:
A powerful technique to identify
the vulnerable plaque.

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145 intravascular elastography

  • 1. CdK ‘02 ICIN Intravascular Elastography: palpating plaques with the finger of IVUS C.L. de Korte1 , F. Mastik1 , J.A. Schaar1 , M. Sierevogel1,3 ,G. Pasterkamp3 , P.W. Serruys1 and A.F.W van der Steen1,2 1 Erasmus University, Thoraxcentre, Rotterdam, The Netherlands 2 Interuniversity Cardiology Institute of the Netherlands 3 Experimental Cardiology Laboratory, University Medical Center, Utrecht, The Netherlands Supported by Netherlands Organization for Scientific Research (NWO) and the Dutch Technology Foundation (STW)
  • 2. CdK ‘02 ICIN Background : Vulnerable plaque que vulnerability : que composition • Large lipid pool Mechanical properties • High strain region • Thin fibrous cap • presence of Macrophages
  • 3. CdK ‘02 ICIN Background : Principle of elastography Soft Harduncompressed compressed • The response of tissue to mechanical excitation (e.g. compression) is a function of its mechanical properties. Force Soft Hard
  • 4. CdK ‘02 ICIN IVUS elastography (t1, P1) (t2,P2) Processing IVUS at 100mmHg IVUS at 80mmHg IVUS elastogram strain 1% 0%
  • 5. CdK ‘02 ICIN strain 1% 0% Picrosirius-red Anti-CD68 antibodyAlpha-actin Circulation 102(6) 617-623 (2000) IVUS elastography plaque characterization
  • 6. CdK ‘02 ICIN strain 1% 0% Picrosirius-red Anti-CD68 antibodyAlpha-actin IVUS elastography vulnerable plaque detection ACC 2002, presentation 1054-20
  • 7. CdK ‘02 ICIN Predictive power of elastography to identify the vulnerable plaque 1 - Specificity 1.00.75.50.25 Sensitivity 1.00 .75 .50 .25 0 Strain 1.26 %: Sensitivity 88% Specificity 89% ACC 2002, presentation 1054-20
  • 8. CdK ‘02 ICIN 0 20 40 60 80 100 120 40 60 80 100 120 140 Frame no. Intra-coronary pressure[mmHg] In vivo elastography Strain [%] 1.0 0.0 Eur Heart J 23(5): 405-413 (2002)
  • 9. CdK ‘02 ICIN Cross-section LAD of patient with U.A.P Strain [%] 2.0 0.0
  • 10. CdK ‘02 ICIN IVUS elastography before atherectomy Strain [%] 1.0 0.0
  • 11. CdK ‘02 ICIN Fibrous cap tissue Fibro-fatty core tissue Histology atherectomy specimen
  • 12. CdK ‘02 ICIN Echogram and elastogram obtained in vivo in Yucatan strain 1% 0% Elastic-von Giesson Picro-Sirius red Acid Phosphatase Polarized light Circulation (2002) in press
  • 13. CdK ‘02 ICIN Tissue mean std Normal segments (n=6) 0.21 0.09 Early fatty lesion (n=9) 0.46 0.17 Early fibrous lesion (n=3) 0.24 0.03 Advanced fibrous lesion (n=6) 0.22 0.04 Strain [%] * Strain and plaque composition in Yucatan Univariate ANOVA on strain Fat p=0.007 MΦ p=0.966 1 - Specificity 1.00.75.50.250.00 Sensitivity 1.00 .75 .50 .25 0.00 Area=0.952 Circulation (2002) in press
  • 15. CdK ‘02 ICIN Conclusion Intravascular Ultrasound Elastography: A powerful technique to identify the vulnerable plaque.